MS-2012-00160_0004.tif Date Paid
Receipt
APP LICATI ON
FENCING CITY RIGHT OF WAY
FEE $10.00 (Refundable if Easement Denied)
N AME OF APPLICANT: �fi L— d" I I
MAILING ADDRESS: Lk - ?
PHONE NU MBER:
LEGAL DES CRIPTION F PROPERTY:
S TREET( BORDERING THE P
HEIGHT C : ®3\ S Residential: Commercial:
TY E C N T U TI ON: Zonin
Sigfiature of Applicant Signature of Applicant
R ecommen d ed Action by Administrator and Public Works Director:
Approve X Deny
If Denied, Reasons for Action:
City Administrator birector of Public W orks
Action by Mayor:
Ap prove Deny
M ayor
A ction by City Council (if necessary):
Approve Deny